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Monday, December 28, 2015

Washington State
has released a draft data dictionary for “native” client data and transaction
requirements that contain changes needed for the April 2016 Washington State
transition from Regional Support Networks (RSNs) providing mental health care to the new Behavioral Health
Organizations (BHOs). BHOs will administer both mental health and substance use
disorders (previously called substance abuse) funds to provide services to medically indigent
individuals and those who have a BHO-eligible Medicaid benefit. Substance Use
Disorder (SUD) providers will begin sending their data via the new data
dictionary as the TARGET system is being removed. In addition, each local BHO
may have additional changes in data and requirements.

It should
also be noted that one region in Washington State, Southwest, will be an “Early
Adopter” region, combining the administration of Medicaid benefits for Mental
Health, Substance Use Disorder and Medical. There will be an Administrative
Services Office for Southwest and many providers in that area may be
contracting with the existing Apple Health Plans (such as Molina, CHPW, etc.)
instead of directly with their designated region. Washington State hopes to
integrate all health services in this manner beginning in 2020.

The
following is a brief summary of the Data Dictionary changes to being April 1,
2016:

All
existing transactions will continue but will be renumbered due to changes in the new
version. Some have been renamed and new transactions—identified by bold
text—have been added:

There are a number of changes to existing transactions
that include, but are not limited to: Changing the transaction
name; re-ordering the data within a transaction; the addition of new,
changed or deleted data and/or data tables; and improved data definitions.

RSN ID has been redefined as “BHO ID” and could
possibly be the ProviderOne ID—further State clarification is needed.

Transactions that include a hospital or facility ID
will now require a facility National Provider Identifier (NPI). This will
replace Reporting Unit (RU) and the State will provide a list of facility
NPIs with an RU cross-walk.

All references to Consumer have been updated to
Client.

There are no transaction header changes.

These data
dictionary changes also come at the same time some RSNs are becoming BHOs,
integrating the substance use disorder services with the mental health benefit
administration. Both of these changes are fairly significant for clinical, as
well as technical staff. These changes will require updates
to internal clinical and business processes, changes to forms and/or data
systems (EHRs), native transaction formats, collection point timelines, and of
course, staff training—all by April 1, 2016. Although this sounds daunting, it
is possible. The immediate first step is to review all changes, determine all
points of impact, and have discussions with your local regions for additional
guidelines and/or data changes to determine the next
steps and resources required .Please note
that 837 changes, identified in the BHO Service Encounter Reporting
Instructions (SERI) do not include structure changes but define the service
(CPT and HCPCS) codes that will be allowable.